Nausea and vomiting during pregnancy (NVP) affects about 70 % of all expectant mothers and commonly impacts their physical health and psychosocial functioning. The aim of this study was to estimate the heritability of the presence, duration and severity of NVP. The sample consisted of 1723 women (M age = 41.78, SD = 11.67) including twins in both complete and incomplete pairs and their sisters from two cohorts participating in the NVP Genetics Consortium. The sample comprised 159 monozygotic and 140 dizygotic complete twin pairs, and 69 twin-sister pairs. We applied an extended twin design using OpenMx and Mx for secondary analysis. Individual differences in NVP were best explained by additive genetic and unique environmental effects. Heritability estimates were 73 % (95 % CIs = 57–84 %) for presence, 51 % (95 % CIs = 36–63 %) for duration and 53 % (95 % CIs = 38–65 %) for severity of NVP. The genetic correlation between duration and severity was almost perfect. Our results show that genes play an important role in different aspects of NVP and justify the importance of searching for genetic variants.
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Attard CL, Kohli MA, Coleman S, Bradley C, Hux M, Atanackovic G, Torrance GW (2002) The burden of illness of severe nausea and vomiting of pregnancy in the United States. Am J Obstet Gynecol 186(5 Suppl Understanding):S220–S227
Bartoshuk LM, Duffy VB, Reed D, Williams A (1996) Supertasting, earaches and head injury: genetics and pathology alter our taste worlds. Neurosci Biobehav Rev 20(1):79–87
Basso O, Olsen J (2001) Sex ratio and twinning in women with hyperemesis or pre-eclampsia. Epidemiology 12(6):747–749
Boker S, Neale M, Maes H, Wilde M, Spiegel M, Brick T, Spies J, Estabrook R, Kenny S, Bates T, Mehta P, Fox J (2011) OpenMx: an open source extended structural equation modeling framework. Psychometrika 76(2):306–317
Cedergren M, Brynhildsen J, Josefsson A, Sydsjö A, Sydsjö G (2008) Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition. Am J Obstet Gynecol 198412(e411-412):e415
Chortatos A, Haugen M, Iversen PO, Vikanes A, Eberhard-Gran M, Bjelland EK, Magnus P, Veierod MB (2015) Pregnancy complications and birth outcomes among women experiencing nausea only or nausea and vomiting during pregnancy in the Norwegian Mother and Child Cohort Study. BMC Pregnancy Childbirth 15:138
Clark S, Hughes B, McDonald SS (2013) The impact of nausea and vomiting of pregnancy on quality of life: report of a national consumer survey and recommendations for improving care. Obstet Gynecol Surv 68(9):S1–S10
Colodro-Conde L, Cross SM, Lind PA, Painter JN, Gunst A, Jern P, Johansson A, Maegbaek ML, Munk-Olsen T, Nyholt DR, Ordoñana JR, Paternoster L, Sánchez-Romera JF, Wright MJ, Medland SE (in press) Cohort profile: nausea and vomiting during pregnancy genetics consortium (NVP genetics consortium). Int J Epidemiol. doi:10.1093/ije/dyv360
Corey LA, Berg K, Solaas MH, Nance WE (1992) The epidemiology of pregnancy complications and outcome in a Norwegian twin population. Obstet Gynecol 80(6):989–994
Corp. I (Released 2013.) IBM SPSS Statistics for Windows, Version 22.0.. In. IBM Corp., Armonk, NY
Czaja JA (1975) Food rejection by female rhesus monkeys during the menstrual cycle and early pregnancy. Physiol Behav 14(5):579–587
Danzer H, Braustein GD, Rasor J, Forsythe A, Wade ME (1980) Maternal serum human chorionic gonadotropin concentrations and fetal sex prediction. Fertil Steril 34(4):336–340
Einarson TR, Navioz Y, Maltepe C, Einarson A, Koren G (2007) Existence and severity of nausea and vomiting in pregnancy (NVP) with different partners. J Obstet Gynaecol 27(4):360–362
Einarson TR, Piwko C, Koren G (2013) Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol 20(2):e171–e183
Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R, Goodwin TM (2008) High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol 141(1):13–17
Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, Goodwin TM (2009) Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 18(12):1981–1987
Flaxman SM, Sherman PW (2000) Morning sickness: a mechanism for protecting mother and embryo. Q Rev Biol 75(2):113–148
Gadsby R, Barnie-Adshead AM, Jagger C (1997) Pregnancy nausea related to women’s obstetric and personal histories. Gynecol Obstet Invest 43(2):108–111
Goecke TW, Ekici AB, Niesler B, Loehberg CR, Hammer C, Rappold G, Schanze D, Straub V, Altmann HH, Strissel P, Strick R, Beckmann MW, Fasching PA (2010) Two naturally occurring variants of the serotonin receptor gene HTR3C are associated with nausea in pregnancy. Acta Obstet Gynecol Scand 89(1):7–14
Hizli D, Kamalak Z, Kosus A, Kosus N, Akkurt G (2012) Hyperemesis gravidarum and depression in pregnancy: is there an association? J Psychosom Obstet Gynaecol 33(4):171–175
Johansson A, Jern P, Santtila P, von der Pahlen B, Eriksson E, Westberg L, Nyman H, Pensar J, Corander J, Sandnabba NK (2013) The genetics of sexuality and aggression (GSA) twin samples in Finland. Twin Res Hum Genet 16(1):150–156
Jueckstock JK, Kaestner R, Mylonas I (2010) Managing hyperemesis gravidarum: a multimodal challenge. BMC Med 8:46
Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, Navioz Y, Ungar WJ (2005) Validation studies of the pregnancy unique-quantification of emesis (PUQE) scores. J Obstet Gynaecol 25(3):241–244
Koren G, Madjunkova S, Maltepe C (2014) The protective effects of nausea and vomiting of pregnancy against adverse fetal outcome–a systematic review. Reprod Toxicol 47:77–80
Louik C, Hernandez-Diaz S, Werler MM, Mitchell AA (2006) Nausea and vomiting in pregnancy: maternal characteristics and risk factors. Paediatr Perinat Epidemiol 20(4):270–278
Matsuo K, Ushioda N, Nagamatsu M, Kimura T (2007) Hyperemesis gravidarum in Eastern Asian population. Gynecol Obstet Invest 64(4):213–216
Mazzotta P, Stewart DE, Koren G, Magee LA (2001) Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy. J Psychosom Obstet Gynaecol 22(1):7–12
McKerracher L, Collard M, Henrich J (2015) The expression and adaptive significance of pregnancy-related nausea, vomiting, and aversions on Yasawa Island, Fiji. Evol Hum Behav 36(2):95–102
Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM (2011) Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. J Perinatol 31(1):10–20
Neale MC, Cardon LR (1992) Methodology for genetic studies of twins and families. Kluwer Academic Publishers, Dordrecht, The Netherlands.
Neale MC, Maes HH (2004) Methodology for genetic studies of twins and families. Kluwer Academic Publishers, The Netherlands
Neale MC, Boker SM, Xie G, Maes HH (2006) Mx: statistical modeling. Department of Psychiatry, VCU Box 900126, Richmond, VA 23298 http://www.vcu.edu/mx/
Niebyl JR (2010) Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 363(16):1544–1550
O’Brien B, Newton N (1991) Psyche versus soma: historical evolution of beliefs about nausea and vomiting during pregnancy. J Psychosom Obstet Gynaecol 12(2):91–120
Ordoñana JR, Perez-Riquelme F, Gonzalez-Javier F, Carrillo E, Gomez-Amor J, Martinez-Selva JM (2006) An initiative in Spain for the study of women’s health: the Murcia Twin Registry. Twin Res Hum Genet 9(6):865–867
Ordoñana JR, Rebollo-Mesa I, Carrillo E, Colodro-Conde L, Garcia-Palomo FJ, Gonzalez-Javier F, Sanchez-Romera JF, Aznar Oviedo JM, de Pancorbo MM, Perez-Riquelme F (2013) The Murcia Twin Registry: a population-based registry of adult multiples in Spain. Twin Res Hum Genet 16(1):302–306
Outlaw WM, Ibdah JA (2005) Impaired fatty acid oxidation as a cause of liver disease associated with hyperemesis gravidarum. Med Hypotheses 65(6):1150–1153
Piwko C, Koren G, Babashov V, Vicente C, Einarson TR (2013) Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol 20(2):e149–e160
Posthuma D, Beem AL, de Geus EJ, van Baal GC, von Hjelmborg JB, Iachine I, Boomsma DI (2003) Theory and practice in quantitative genetics. Twin Res 6(5):361–376
Poursharif B, Korst LM, Fejzo MS, MacGibbon KW, Romero R, Goodwin TM (2008) The psychosocial burden of hyperemesis gravidarum. J Perinatol 28(3):176–181
Rijsdijk FV, Sham PC (2002) Analytic approaches to twin data using structural equation models. Brief Bioinform 3(2):119–133
Rodien P, Bremont C, Sanson ML, Parma J, Van Sande J, Costagliola S, Luton JP, Vassart G, Duprez L (1998) Familial gestational hyperthyroidism caused by a mutant thyrotropin receptor hypersensitive to human chorionic gonadotropin. N Engl J Med 339(25):1823–1826
Rodien P, Jordan N, Lefevre A, Royer J, Vasseur C, Savagner F, Bourdelot A, Rohmer V (2004) Abnormal stimulation of the thyrotrophin receptor during gestation. Hum Reprod Update 10(2):95–105
Sipiora ML, Murtaugh MA, Gregoire MB, Duffy VB (2000) Bitter taste perception and severe vomiting in pregnancy. Physiol Behav 69(3):259–267
Smith C, Crowther C, Beilby J, Dandeaux J (2000) The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 40(4):397–401
Uguz F, Gezginc K, Kayhan F, Cicek E, Kantarci AH (2012) Is hyperemesis gravidarum associated with mood, anxiety and personality disorders: a case-control study. Gen Hosp Psychiatry 34(4):398–402
Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ (2011) Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 118(11):1302–1313
Verweij KJ, Mosing MA, Zietsch BP, Medland SE (2012) Estimating heritability from twin studies. Methods Mol Biol 850:151–170
World Health Organization (2010) International statistical classification of diseases and related health problems, 10th revision. World Health Organization, Geneva
Zhang Y, Cantor RM, Macgibbon K, Romero R, Goodwin TM, Mullin PM, Fejzo MS (2011) Familial aggregation of hyperemesis gravidarum. Am J Obstet Gynecol 204(3):230 e231–230 e237
Zietsch BP, Lee AJ, Sherlock JM, Jern P (2015) Variation in women’s preferences regarding male facial masculinity is better explained by genetic differences than by previously identified context-dependent effects. Psychol Sci 26(9):1440–1448. doi:10.1177/0956797615591770
The GSA group is grateful to the twins and siblings of twins for their participation. We are indebted all GSA staff, past and present. MTR is grateful to the twins for their participation in the Murcia Twin Registry. We are grateful to Nicholas G. Martin for his comments on previous versions of this work and to Baptiste Couvy-Duchesne for his support in the data analyses.
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
Informed consent was obtained from all individual participants included in the study. Data collections were approved by the relevant Ethics Committees in each of the participant institutions (Ethics Committee of the Åbo Akademi University and Committee of Research Ethics of the University of Murcia) and follow the relevant national regulations regarding data protection. The Helsinki Declaration, as well as applicable institutional and governmental regulations concerning the ethical use of human volunteers, were followed during all the phases of this research.
The GSA data collection was funded by The Academy of Finland [Grant Number 138291]. The MTR is funded by Fundación Séneca - Agencia de Ciencia y Tecnología de la Región de Murcia, Murcia, Spain [08633/PHCS/08, 15302/PHCS/10] and the Spanish Ministry of Science and Innovation [Grant Numbers PSI2009–11560]. The NVP Genetics Consortium is supported by the Australian National Health and Medical Research Council [Grant Number APP1084325]. This work was also supported by Fundación Séneca - Agencia de Ciencia y Tecnología de la Región de Murcia, Murcia, Spain [19151/PD/13 to L.C.C.] and by The Academy of Finland [284385, 274521 to P.J.].
Edited by Yoon-Mi Hur
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Colodro-Conde, L., Jern, P., Johansson, A. et al. Nausea and Vomiting During Pregnancy is Highly Heritable. Behav Genet 46, 481–491 (2016). https://doi.org/10.1007/s10519-016-9781-7
- Nausea and vomiting during pregnancy
- Morning sickness
- Twin study
- Women’s health
- NVP Genetics Consortium